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General NPI Number Information
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NPI Number | 1053490979
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Entity Type | Organization
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Legal Business Name | MATTHEW J. EMERY, OD, P.C.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10772 W CARSON CITY RD
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City | GREENVILLE
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State | MI
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Zip | 48838-9141
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Country | US
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Telephone | 616-754-5427
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Fax | 616-754-5428
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Provider Business Mailing Address
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Address Line | 4065 WHIRLWIND DR NE
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City | ROCKFORD
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State | MI
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Zip | 49341-8291
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Country | US
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Telephone | 616-754-5427
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Fax | 616-754-5428
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW EMERY
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Credential | OD
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Telephone | 616-754-5427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004005
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License Number State | MI
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